The proposed research focuses on a largely high risk yet understudied population for HIV infection in two African countries (Rwanda and Zambia), namely HIV discordant couples (when one partner is HIV positive and the other is HIV negative). Research shows that couples'voluntary counseling and testing (CVCT) has been highly successful at reducing HIV transmission to the negative partner, yet research also shows that once couples are aware of their serodiscordant status and receive counseling on HIV prevention, not all couples are able to use the available condoms correctly and/or consistently enough to prevent transmission to the negative partner. This study seeks to investigate the behavioral barriers (individual, couple, and socio-cultural) that prevent consistent and correct condom use within long-term relationships and how these barriers can be overcome. Findings from the proposed research will advance our understanding of sustainable risk reduction and guide the development of a culturally appropriate intervention to target couples identified as inconsistent condom users. Collaborating with the two largest HIV discordant research sites in the world in Lusaka, Zambia, and Kigali, Rwanda, this study builds upon preliminary quantitative and qualitative studies conducted by the applicant;aids in the refinement of risk reduction counseling messages and intervention development;builds upon a biomedical infrastructure that introduces the potential of behavioral focused approaches that also may contribute to more effective health care utilization and access and policy changes;and supports the NIMH Division of AIDS and Health and Behavior Research goals to use behavioral approaches to translate research into interventions to reduce HIV risk behaviors and disease burden. Based upon preliminary findings, a quantitative questionnaire has been developed and will be disseminated to 330 randomly selected couples at each of the two research sites (N=660). Couples'selection at each site will be equally split between the two types of HIV serodiscordant couples (male positive/female negative and male negative/female positive). Analyses will include descriptive statistics, concordance of agreement between husbands and wives'responses, and hierarchical linear modeling. PUBLIC HEALTH RELEVANCE: With the global call for HIV serostatus knowledge and the expansion of voluntary counseling and testing to help curb the HIV epidemic, there is a crucial need for the investigation and understanding of behavioral factors that prevent consistent and correct condom use among couples in which one partner is HIV positive. A greater understanding of factors that disrupt condom use among long-term users is the critical next step in the development of HIV prevention and intervention.